Risk threshold for starting low dose aspirin in pregnancy to prevent preeclampsia: an opportunity at a low cost

PloS One
Emily BartschJoel G Ray

Abstract

Preeclampsia (PE) increases maternal and perinatal morbidity and mortality. Based on a multitude of data from randomized clinical trials, clinical practice guidelines endorse using ASA to prevent PE in women who are "at risk." However, data are lacking about the level of absolute risk to warrant starting ASA prophylaxis. We present two approaches for objectively determining the minimum absolute risk for PE at which ASA prophylaxis is justified. The first is a new approach-the minimum control event rate (CERmin). The second approach uses a pre-existing concept-the minimum event rate for treatment (MERT). Here we show how the CERmin is derived, and then use the CERmin and the MERT to guide us to a reasonable risk threshold for starting a woman on ASA prophylaxis against PE based on clinical risk assessment. We suggest that eligible women need not be at "high risk" for preeclampsia to warrant ASA, but rather at some modestly elevated absolute risk of 6-10%. Given its very low cost, its widespread availability, ease of administration and its safety profile, ASA is a highly attractive agent for the prevention of maternal and perinatal morbidity worldwide.

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Citations

Jan 29, 2016·Fertility and Sterility·Ashley TruongRaymond W Ke
Apr 30, 2017·American Journal of Obstetrics and Gynecology·Mary Catherine TolcherKjersti M Aagaard
Mar 8, 2017·Best Practice & Research. Clinical Obstetrics & Gynaecology·Birgit Arabin
Sep 16, 2016·Obstetric Medicine·Stefan C Kane
Jun 12, 2020·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·Aswathi JayaramJames N Martin
Jan 24, 2017·Molecular Medicine Reports·Shu-Jun LiGuo-Gang Zhang
Feb 15, 2018·The Journal of Obstetrics and Gynaecology Research·Tuangsit WataganaraSurasak Angsuwathana
Aug 10, 2021·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·Hao ZhuWeirong Gu

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